Healthcare Provider Details

I. General information

NPI: 1962409375
Provider Name (Legal Business Name): KALEEM U HAQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD STE 3
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD STE 3
BALTIMORE MD
21239-2905
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-3775
  • Fax: 443-444-4678
Mailing address:
  • Phone: 443-444-3775
  • Fax: 443-444-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0050282
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: